Balance Billing Scams $1 Billion

September 3rd, 2008 | Sources: Business Week


When a provider believes an insurer has reimbursed too little for care they have rendered to a patient, they often send a “balance bill” to the patient for the difference. These bills tend to be confusing and threatening. Many patients pay these bills without question.

The problem is that laws in 47 states and those governing Medicare prohibit providers from billing insured patients for even a nickel more than the plan-specified co-insurance or co-payments. If providers feel their reimbursement has been too low, these laws state that their recourse is with the insurance company, not the patient.

Economists cited in a Business Week expose on balance billing estimate that patients fork out at least $1 billion per year to cover bills for which they are not legally responsible.

If you think you are having a balance billing problem, remember that you are entitled to dispute any part of your bill. You can contact a billing investigator, the Better Business Bureau, or the Attorney General’s office in your state.


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